Day Of Resumption Research Articles

Metabolic adjustment and regulation of gene expression are essential for increased resistance to severe water deficit and resilience post-stress in soybean.

BackgroundSoybean is the main oilseed crop grown in the world; however, drought stress affects its growth and physiology, reducing its yield. The objective of this study was to characterize the physiological, metabolic, and genetic aspects that determine differential resistance to water deficit in soybean genotypes.MethodsThree soybean genotypes were used in this study, two lineages (L11644 and L13241), and one cultivar (EMBRAPA 48-C48). Plants were grown in pots containing 8 kg of a mixture of soil and sand (2:1) in a greenhouse under sunlight. Soil moisture in the pots was maintained at field capacity until the plants reached the stage of development V4 (third fully expanded leaf). At this time, plants were subjected to three water treatments: Well-Watered (WW) (plants kept under daily irrigation); Water Deficit (WD) (withholding irrigation until plants reached the leaf water potential at predawn of −1.5 ± 0.2 MPa); Rewatered (RW) (plants rehydrated for three days after reached the water deficit). The WW and WD water treatments were evaluated on the eighth day for genotypes L11644 and C48, and on the tenth day for L13241, after interruption of irrigation. For the three genotypes, the treatment RW was evaluated after three days of resumption of irrigation. Physiological, metabolic and gene expression analyses were performed.ResultsWater deficit inhibited growth and gas exchange in all genotypes. The accumulation of osmolytes and the concentrations of chlorophylls and abscisic acid (ABA) were higher in L13241 under stress. The metabolic adjustment of lineages in response to WD occurred in order to accumulate amino acids, carbohydrates, and polyamines in leaves. The expression of genes involved in drought resistance responses was more strongly induced in L13241. In general, rehydration provided recovery of plants to similar conditions of control treatment. Although the C48 and L11644 genotypes have shown some tolerance and resilience responses to severe water deficit, greater efficiency was observed in the L13241 genotype through adjustments in morphological, physiological, genetic and metabolic characteristics that are combined in the same plant. This study contributes to the advancement in the knowledge about the resistance to drought in cultivated plants and provides bases for the genetic improvement of the soybean culture.

Resuming Anticoagulation following Upper Gastrointestinal Bleeding among Patients with Nonvalvular Atrial Fibrillation-A Microsimulation Analysis.

Among patients with nonvalvular atrial fibrillation (NVAF) who have sustained an upper gastrointestinal bleed (UGIB), the benefits and harms of oral anticoagulation change over time. Early resumption of anticoagulation increases recurrent bleeding, while delayed resumption exposes patients to a higher risk of ischemic stroke. We therefore set out to estimate the expected benefit of resuming anticoagulation as a function of time after UGIB among patients with NVAF. We created a decision-analytic model estimating discounted quality-adjusted life-years when patients with NVAF resume anticoagulation on each day following UGIB. We simulated from a health system perspective over a lifelong time horizon. Peak utility for warfarin was achieved by resumption 41 days after hemostasis from the index UGIB. Resumption between days 32 and 51 produced greater than 99.9% of the peak utility. Peak utility for apixaban was achieved by resumption 32 days after the index UGIB. Resumption between days 21 and 47 produced greater than 99.9% of the peak utility. Of input parameters, results were most sensitive to underlying stroke risk. Specifically, across the range of CHA2DS2-Vasc scores, the optimal day of resumption varied by around 11 days for patients resuming warfarin and by around 15 days for patients resuming apixaban. Results were less sensitive to underlying risk of rebleeding. For patients with NVAF following UGIB, warfarin is optimally restarted approximately six weeks following hemostasis, and apixaban is optimally restarted approximately one month following hemostasis. Modest changes to this timing based on probability of thromboembolic stroke are reasonable.

Reducing the exposure of the tonsillar fossa does not impact postoperative pain levels in children undergoing tonsillectomy: A double-blind randomized controlled trial

BackgroundIt is not established whether reducing the exposure of the tonsillar fossa would be an effective strategy for postoperative pain relief among the pediatric population submitted to tonsillectomy. We assessed the impact of closing this region using absorbable sutures on pain, on the resumption of normal diet and on the healing process until seven days after surgery. MethodsRandomized, double-blind, controlled trial comparing postoperative pain in 132 children between the ages of 5 and 12 years undergoing tonsillectomy having bilateral closure, unilateral closure or non-closure of the tonsillar fossa. ResultsNo differences in pain levels were reported both at discharge and on postoperative day 7. The day of resumption of normal diet was similar in all patients. Less granuloma and edema of the uvula were noted in patients with non-closure of the tonsillar fossa. ConclusionThese results showed that reducing the exposure of the tonsillar fossa after the removal of the palatine tonsils was not an effective method for postoperative pain relief in children. Moreover, its closure was associated with slower healing.

Writing a research article. Are we ignoring the basics?

We have read the article ‘Comparative study between staplers and conventional (hand-sewn) anastomosis in gastrointestinal surgery’ by Bangaru et al. [1] with interest. The authors had evaluated the two techniques in three different types of surgical procedures with 40 patients assigned to each procedure group. At this point, the authors had only mentioned of random allocation of patients in each group into the two treatment arms comprising of stapler and hand-sewn anastomosis, respectively. A more detailed description of the technique of randomization and the method of blinding employed would have enlightened the readers about the study protocol. The table for inclusion criteria is showing indications for the different procedures and the number of patients undergoing each procedure instead of highlighting the basis on which the patients were selected for the study. Defining the primary outcome measure of a study is important from the point of view of sample size calculation. The present study had listed total operating time, time to return of bowel sounds, day of resumption of oral feeds, postoperative hospital stay and anastomotic leak as the outcome parameters without categorizing them into primary and secondary outcome measures; thus, the basis on which the sample size of 120 patients was calculated is not clear to us. The method, result and discussion sections in this article did not strictly adhere to their intended purpose as data interpretation was carried out in all the three sections. A table showing baseline characteristics of included patients is mandatory when presenting data in a comparative study. Description of data has two components: central tendency (mean, median, mode) and dispersion (standard deviation, interquartile range). The authors had reported all their data in the form of mean value only without mentioning degree of dispersion. This incomplete information does not allow further statistical analysis to be contemplated including calculation of the unpaired t test as mentioned by the authors in the abstract section only. Figures and graphs should be self-explanatory and easily interpreted by the readers. The graphs provided in this article did not mention the units of measurement in both the abscissa and ordinate. The discussion section should explain any significant difference observed in the outcome measures and its relevance in the light of similar other existing studies rather than merely reporting the results and its concordance to published literature. Likewise, it will be interesting to know the reasons for delayed discharge of patients following colorectal anastomosis even though they were started early on oral feeds than the gastrojejunostomy group. The need for a long follow-up period of 2–22 months should also be clarified as the last outcome parameter (anastomotic leak) can always be detected in the immediate postoperative period. Lastly, we would like to appeal to all the contributing authors that devoting a little extra effort and attention to correct presentation of data will supplement their hard and painstaking research work and will help to achieve the long-cherished goal of establishing IJS as a leading global surgical journal.

The effect of a clinical pathway for enhanced recovery of rectal resections on perioperative quality of care

There is ample evidence of the benefits of clinical pathways (CPs), but this study is the first to investigate the potential additional benefits of a CP for rectal resections in a setting with an already established policy of enhanced postoperative recovery. We compared 36 patients who underwent rectal resections with ileostomy placement and were treated according to a CP (CP group) with 67 patients treated before CP implementation (prepathway group). Indicators of process quality were placement of central venous line and epidural catheter, day of removal of Foley catheter in relation to removal of the epidural catheter, day of first mobilization, day of resumption of regular diet, day of first passage of stool through the stoma, and length of stay. Outcome quality was assessed by morbidity, mortality, reoperation, and readmission rates. We found that patients in the CP group resumed regular diet significantly sooner (p = 0.001). There were no significant differences regarding the day of first mobilization (p = 0.69), epidural catheter (p = 0.74), central venous line placement (p = 0.92), and removal of Foley catheter (p = 0.23). The first stool was passed through the stoma earlier (p = 0.04) in the prepathway group. Median length of hospital stay was significantly shorter in the CP group (12.5 vs. 15.0 days; p = 0.008). There were no significant changes in outcome quality, except for a significantly higher need for revisional surgery in the CP group (13.9 vs. 3%, p = 0.05). After implementation of a CP for rectal resections, one parameter of process quality improved and length of stay decreased.

Comparison of non-mesh (Desarda) and mesh (Lichtenstein) methods for inguinal hernia repair among black African patients: a short-term double-blind RCT

This study compared the short-term outcomes of the non-mesh (Desarda) and mesh (Lichtenstein) methods of hernia repair among Black African patients, with regard to acute postoperative pain, day of return to normal gait, operative time and complications. A total of 101 participants (51 in the Lichtenstein arm and 50 in the Desarda arm) were enrolled into this single centre double-blind randomised controlled trial. The outcome measures were evaluated at 1-2 h, 3, 7 and 14 days. The power of the study was set at 80%, CI at 95% and a two-sided P < 0.05 was considered statistically significant. There was no significant difference in the mean pain score (based on Visual Analogue Scale 0-10) between the study arms [3rd postoperative day (POD): 3.33 ± 1.75 for Lichtenstein and 2.73 ± 1.64 for Desarda, Effect size (CI): 0.59 (-0.088-1.272) and the scores on the 7th POD were 1.31 ± 1.19 for Lichtenstein and 1.31 ± 1.34 for Desarda, effect size (CI): 0.00 (-0.509-0.509)]. No difference was observed in regard to mean day of resumption of normal gait [2.44 ± 1.62 for Lichtenstein and 2.06 ± 1.13 for Desarda, effect size (CI): 0.08 (-0.030-0.193)]. A significant difference was recorded in regard to operative time, with the Desarda repair markedly shorter in duration [15.9 ± 3.52 min for Lichtenstein repair and 10.02 ± 2.93 min for Desarda's repair, effect size (CI): 5.92 (4.62-7.20), P = 0.0001]. Complication rates were similar in the two study arms. The results of the study showed that the effectiveness of the Desarda technique with respect to influencing the early clinical outcomes of hernia repair is similar to that of the Lichtenstein method. However, the operator in this study showed that the Desarda repair requires significantly shorter operative time.

Possibilités de bouturage chez &lt;i&gt;Maerua crassifolia Forssk., Capparaceae&lt;/i&gt;, un ligneux fourrager Sahélien

Possibilities of propagation by cutting at maerua crassifolia forssk.,capparaceae, a sahelian fodder tree Characteristics of the cutting of Maerua crassifolia, a sahelian fodder tree, and their monthly variations were established with cuttings resulting from plantations obtained byartificial regeneration. On a branch of stem, we distinguished closed, median and distant parts. Work took place during hot dry period, in May, April, June and July. The time of resumption is the same one for the various types of cuttings in April. For this month, the most elevated resumption rate (86.70 %) has been gotten with closed cuttings with a length of 19 days of resumption. The weakest resumption rate has been raised to themonth of May, in spite of a length of 9 days of resumption. The month of July, with 91.30 % of resumption and a length of 19 days appears most auspicious. In the same way the delay of resumption was of 2 days.

Clinical factors influencing the sensitivity to warfarin when restarted after surgery

Resumption of oral anticoagulation after surgery may result in a different maintenance dose of warfarin than before the procedure. Knowledge of the clinical determinants of postoperative response could help avoid excessive anticoagulation in sensitive patients or avoid extended delays in achieving a therapeutic level in resistant patients. Retrospective review. Two hundred warfarin-treated patients who were managed by our clinic for surgery. Two independent adjudicators classified the postoperative response to warfarin as Resistant, Normal or Sensitive, based on previous maintenance dose, international normalized ratio (INR) on the day of resumption, number of days until INR of >1.9 and doses of warfarin given. A third adjudicator resolved disagreements. Clinical data were extracted from the patient records and correlated with the response. Interobserver agreement for classification of postoperative response was moderate (weighted kappa 0.46) with 37 (18.5%) considered resistant, 135 (67.5%) normal, 27 (13.5%) sensitive and one patient was not classifiable. The main type of surgery was cardiac. In univariable analysis only addition of amiodarone after surgery was associated with a sensitive response (P = 0.04). After adjustment for all other factors with an ordered categorical response, amiodarone remained as the sole independent risk factor (P = 0.02) for a sensitive response, odds ratio 0.41 (95% confidence interval 0.19-0.89) for Normal instead of Sensitive or for Resistant instead of Normal. Altered sensitivity to warfarin occurs in about one-third of patients after surgery and can be predicted by the introduction of concomitant amiodarone therapy but not by patient factors or the nature of the procedure. Changes in concomitant medications after surgery should alert doctors of the potential for increased sensitivity to warfarin.

Maintenance of Therapeutic Concentrations of Caspofungin after Temporary Treatment Interruption (48 Hours) in a Child with Invasive Aspergillosis

Caspofungin is an antifungal drug active as a rescue treatment for invasive aspergillosis in cancer patients (4), with a MIC level of 0.5 mg/liter (2) and a minimum target concentration of 1 mg/liter (5, 6). In adults, these levels are achieved after a loading dose of 70 mg on the first day, followed by 50 mg once a day in the following days (5), while in children, a dose of 50 mg/m2 without a loading dose is required (6). We observed an 8-year-old girl with a previous pulmonary aspergillosis following allogeneic hemopoietic stem cell transplant for Pearson's syndrome that relapsed concomitant with the development of posttransplant acute myeloblastic leukemia (1). The infection relapsed during liposomal amphotericin B secondary prophylaxis; voriconazole treatment was not feasible because of concomitant barbiturate therapy (3), and therefore, caspofungin at 50 mg/m2 (5) (i.e., 30 mg/day) was administered. The patient was in poor clinical and psychological condition and refused any hospital stay; therefore, after 8 days of in-hospital treatment, the patient was discharged for the weekend. No antifungal treatment was administered for two days, and then the patient was admitted again to restart therapy. Blood samples for the determination of caspofungin blood concentrations were taken on the last day of treatment (Friday) and the first day of restarting treatment (Monday), before (through) and 30 min after the end (peak) of caspofungin infusion. The samples were stored at −80°C and sent to the Department of Pharmacology of the University of Florence for the determination of caspofungin blood levels. Caspofungin concentrations were determined by high-pressure liquid chromatography (lowest sensitivity limit, 0.125 mg/liter). A Chromsep C8 4.6-by-250-mm 5-μm column preceded by an adequate precolumn was used for the analysis; a flow rate of 1.3 ml/min was used. The fluorescence detector excitation and emission wavelengths were set at 220 and 304 nm, respectively. The drug was isolated from the plasma by solid-phase extraction (5). The caspofungin levels that resulted were 6.7 mg/liter through and 11.5 mg/liter peak on the last day of treatment and 1.9 mg/liter through and 5.6 mg/liter peak on the first day of resumption of therapy. Even after a 48-h interruption, the caspofungin blood concentration was above the required target concentration for the treatment of invasive aspergillosis (2, 5, 6). Even if further studies are needed to confirm this observation, our experience suggests that the administration of caspofungin for 5 days/week, after an adequate period (at least 1 week) of daily therapy, may be a possible approach for children with invasive aspergillosis who cannot receive other antifungal drugs and may not be hospitalized for some reason.

Changes in the responsiveness of hen anterior pituitary to cLHRH-II during induced molting

The goal of this study was to determine whether the responsiveness of the anterior pituitary to cLHRH-II in relation to luteinizing hormone-β subunit (LHβ) mRNA expression is improved by induced molting. White Leghorn hens were subjected to induced molting by feed withdrawal for 4 days. The anterior pituitaries were collected from hens of pretreatment (PT), 1 day after resumption of feeding (1DRF) and on the day of resumption of laying (RL). They were processed for organ culture in the medium with or without cLHRH-II, followed by reverse transcription and competitive PCR. When pituitary tissues were incubated without cLHRH-II, the expression of LHβ mRNA did not show any significant difference between PT and RL group hens. In contrast, the expression of LHβ mRNA in the pituitaries that were incubated with cLHRH-II was significantly greater in RL group hens than those in PT and 1DRF groups. Among PT, 1DRF, and RL groups only RL hens showed significant increase of LHβ mRNA synthesis when compared with control (without cLHRH-II). These results suggest that the responsiveness of the anterior pituitary to cLHRH-II increased in postmolt hens, indicating that the functions of this organ might be improved by induced molting.

Changes in the mRNA Expression of TGF&amp;beta; Receptor Types II and III in the Anterior Pituitary during Induced Molting in Hens

The goal of this study was to determine whether TGFβ receptors mRNA were expressed in the chicken anterior pituitary, and their expressions were changed during induced molting by the regulation of feeding. White Leghorn laying hens were subjected to induced molting. The anterior pituitary tissues were collected from hens of pretreatment (PT), 3d after withdrawal of feeding (3DWF), 1d and 5d after the resumption of feeding (1DRF and 5DRF, respectively), and on the day of resumption of egg-laying (RL). They were processed for semi-quantification of TGFβ receptors type II (TβRII) and type III (TβRIII) mRNA expressions by reverse transcription-polymerase chain reaction (RT-PCR). The TβRII and TβRIII mRNA expressions were observed in the anterior pituitaries in all groups of hens. The expression of TβRII and TβRIII βmRNA significantly declined in the 1DRF hens and recovered by the resumption of laying. These results suggest that TGFβs may play role as a local regulator of the glandular cell population and/or differentiation during induced molting.

Changes in the expression of TGFβ-isoforms in the anterior pituitary during withdrawal and resumption of feeding in hens

Our goal was to determine whether TGFβ-isoforms were involved in the remodeling of the pituitary cell population which occurred by regulation of feeding. The current study examined whether TGFβ-isoforms were produced in the anterior pituitary, and the mRNA expression of TGFβ-isoforms changed during withdrawal and resumption of feeding. White Leghorn laying hens were subjected to feed withdrawal for 4 days with a resumption of feeding thereafter. The anterior pituitary tissues were collected from hens of pretreatment (PT), 3 days after feed withdrawal (3DFW), 1 and 5 days after the resumption of feeding (1DRF and 5DRF, respectively), and on the day of resumption of egg-laying (RL). They were processed for semi-quantification of TGFβ2, β3, and β4 mRNA expressions by reverse transcription-polymerase chain reaction (RT-PCR) and for immunocytochemistry for TGFβ3. TGFβ2, TGFβ3, and TGFβ4 mRNA expression with a product size of 269, 236, and 163 bp, respectively, was observed in the anterior pituitaries in all groups of hens. Although the expression of TGFβ2 and TGFβ4 mRNA did not show any significant change, that of TGFβ3 mRNA significantly declined in the 1DRF hens and recovered by the resumption of laying. Immunostaining revealed that TGFβ3 was located in the cytoplasm of glandular cells with granule forms in all groups of hens. The ovarian and oviductal weights sharply declined in the 3DFW and 1DRF groups, followed by a full recovery in the RL hens. These results indicate that TGFβ2, β3, and β4 were expressed in the chicken anterior pituitary, and TGFβ3 mRNA expression was changed in correlation with the regulation of feeding, suggesting that this isoform may play a significant role in the regulation of the glandular cell population and/or differentiation.

Laparoscopic Colectomy for Dukes A Colon Cancer

The use of laparoscopic surgery to treat colon cancer has been well studied; however, the specific use of laparoscopic colectomy for Dukes A colon cancer has not been evaluated. The data of laparoscopic colectomy were compared with those of conventional open colectomy, and the surgical results of patients who underwent surgery for Dukes A colon cancer were evaluated. Between November 1993 and October 1997, 20 patients underwent laparoscopic colectomy for Dukes A colon cancer. Operation time, blood loss, first passage of flatus, day of resumption of oral intake, length of hospital stay after surgery, and number of dissected lymph nodes were compared between 20 patients who underwent laparoscopic colectomy and 23 patients who underwent conventional open colectomy for Dukes A colon cancer. In patients with laparoscopic colectomy, when compared with those with conventional open colectomy, mean blood loss was less (103 g vs. 318 g), flatus returned more quickly (3.5 days vs. 4.2 days), oral intake resumed earlier (3.7 days vs. 4.7 days), and postoperative hospital stay was shorter (16.4 days vs. 24.6 days). The mean number of dissected lymph nodes was not different between the two groups (9.2 vs. 9.2 for D2 dissection). No patient had port-site metastasis or recurrence during a follow-up period from 13 to 60 months (median, 38 months). Review of the literature and the authors' findings indicated that none of the 142 reported patients had port-site metastasis after laparoscopic colectomy for Dukes A colon cancer. The results indicate that laparoscopic colectomy is safe and useful when applied to patients with Dukes A colon cancer and performed carefully by trained surgeons.

Insulin stimulation of growth in diabetic rats. Synthesis and degradation of ribosomes and total tissue protein in skeletal muscle and heart.

Skeletal muscle and heart of diabetic rats show a substantial decline in the rate of protein synthesis associated with decreases in both the number and activity of tissue ribosomes. We have examined the reversal of these changes during the first 3 days of resumption of insulin therapy to rats that had been diabetic for 4 days. Rates of ribosome degradation, which had been elevated in both muscle and heart of the diabetic animals, were suppressed virtually to zero after 1 day of insulin treatment. Synthesis of ribosomes was stimulated, but this change occurred more gradually. Similar, but less dramatic, changes occurred in the rates of synthesis and degradation of total protein in these tissues.